I was asked in an interview last week how I thought we could improve our treatment system for people who use drugs. I’ve been thinking about this question a lot lately because I am regularly seeing the shortcomings of our current system, whether it is through stories people tell me or through patient encounters in the back of an ambulance.
The vast majority of treatment programs in the United States, including the one I went through, use a similar model: 1–2 weeks of detox, a 28 day program, discharge planning with an intensive outpatient program and a “prescription” to attend 90 AA meetings in 90 days. This model has been around for some time and doesn’t appear to be very effective. Many of the people I went through early recovery with have died.
The fatal flaw of this model is that is is built on the foundation that on Day 1 of your recovery journey, it demands total abstinence as the price of entry. If abstinence is your goal for recovery, why would we demand that be a requirement for the first day? It doesn’t really make any sense and immediately sets people up to feel like this end goal is unachievable for them. It creates a climate where relapse becomes secretive, in fear that you will disappoint your friends and family who are rooting for you or paying for your treatment. Relapse means starting your recovery count from Day 1 again, which doesn’t give people any credit for other positive steps they have taken in that same time span.
If you were on a road trip from New York to Florida and got a flat tire in North Carolina, you would pull over, stop, assess the damage, fix your flat, and continue on with your trip. You don’t get propelled back to New York because of a flat tire. You fix it and you move on. You can phone a friend or family for help. No one tells you that you’re a failure for getting a flat and delaying your trip. Things happen and we move forward.
I feel like the harm reduction label is used to describe people who are not in recovery but rather still in active use and not ready for treatment. I was recently asked why the Never Use Alone hotline doesn’t try to encourage people to go into treatment. My response: they already are in recovery by using our hotline. They’re already on their journey towards living a healthier life. Recovery is not defined by abstinence. It is defined by an individual’s goals towards creating change.
I am sorry to anyone I have made feel like their abstinence was a requirement for progress. I wish I could go back in time and tell the people I’ve lost that I would sit with them while they were using to keep them safe. It has taken me many years to unlearn the stigmatizing philosophy that I was taught in rehab and in my short stint in AA.
Many families struggle with this concept. They are taught that sending their loved one to rehab and supporting their abstinence is the only path to helping them. They are taught that certain behaviors are enabling and to let their kids hit rock bottom.
I am begging you to challenge that way of thinking. Treatment begins in your home and in your way of thinking. Tell your child that you love them no matter where they are in their journey. Ask them to leave the door unlocked if they’re using and to let you know so you can check on them, the same way you used to check in on them when they were younger. Go to your local syringe exchange and get trained in how to use Narcan. Let your kid know that you’ve been trained. Encourage them to sign up for Medication Assisted Treatment like Suboxone or Methadone. Cry with them when they are struggling. Laugh with them when they’re having a good day. Help them make an appointment with a primary care doctor. Learn about basic wound care.
Celebrate any achievement and forgive mistakes. Relapse is not failure. Don’t be mad at yourself either. You are doing your best.